“Maintaining an understanding of appropriate pain management can better help physicians ensure legitimate patients get the pain relief they need while helping to prevent prescription drug abuse and diversion,” said Jeremy A. Lazarus, MD, AMA immediate past president. “Over the past decade, the AMA has offered pain-management training to prescribers, and this updated educational program will help physicians better develop the skills needed to evaluate and manage patients with persistent pain.”

Previously updated in 2010, the course materials acknowledge the growing controversy surrounding the appropriate prescribing of opioids for patients with chronic noncancer pain. More than 16,000 Americans a year die of overdoses in which opioids are implicated, and the medicines are involved in about 400,000 emergency department visits annually, according to federal government estimates.

The AMA’s educational materials, completed in consultation with more than a dozen pain-management experts, note the lack of definitive evidence on the effectiveness of opioids over several years in patients with chronic, nonmalignant pain. But they also steer clear of providing a black-and-white view on opioid prescribing.

Although the proper use of opioids is the hot-button issue covered, many other topics in pain management are comprehensively addressed. The course includes modules on the pathophysiology of pain, medical-legal factors, and the treatment of pain in senior patients and patients with substance abuse concerns. The evidence on treatments such as nonsteroidal anti-inflammatory drugs, physical and occupational therapy, cognitive behavioral therapy, and surgical and interventional approaches also is covered.

The content is free to everyone. The CME has been certified for AMA PRA Category 1 Credit, available to physicians who complete the training and pay a fee of $6 per module (link).

“The goal from the clinical perspective is a balanced approach by which clinicians neither reject the use of opioids nor use them without due regard for the risks associated with abuse, addiction, diversion and unintentional overdose,” the updated CME materials say.

The problem of widespread pain

Nearly 120 million Americans struggle with chronic pain each year, and the medical charges and lost productivity linked to that pain costs the U.S. more than $600 billion annually, according to a June 2011 Institute of Medicine report (link). The IOM panel called for an aggressive national strategy to combat the problem of undertreated pain.

The pain management CME update was funded by a grant from the Substance Abuse and Mental Health Services Administration, as part of the AMA’s partnership in the Prescribers’ Clinical Support System for Opioid Therapies. Other members in the partnership include the American Academy of Addiction Psychiatry, the American Dental Assn. and the American Osteopathic Academy of Addiction Medicine.

The SAMHSA grant also is funding a series of 12 AMA webinars, covering topics such as opioid rotation, urine-drug testing and multidimensional chronic pain care. Six webinars have been completed and archived for free viewing online (link). Another six will be offered by June 30, 2014.